Malignant perforation peritonitis: Challenge to a general surgeon (#1152)

Background:Perforations are most common
surgical emergencies seen worldwide, often managed by general surgeons. Situation
worsens when the cause of perforation turns out to be malignant. It is an open
challenge for the surgeon to proceed the case without adequate investigations. The
management and outcome in such cases varies from that of perforation
peritonitis caused by other aetiologies.

Aim:This
study was done to know the spectrum of etiopathology, clinical presentation,
management and treatment outcomes of patients admitted with malignant perforation
peritonitis in our hospital.

Methods:A prospective study was done over
a period of 3 years from January 2011 to December 2013 in a tertiary centre which
included 1400 patients diagnosed with perforation peritonitis. 78 cases were
found to have malignant perforations. We collected data on age, sex, tumour
stage, histological finding, surgical treatment, morbidity and mortality.

Results:Majority (62.8%) were males. Mean
age of presentation was 59.1 years. The time taken for resuscitation and
preparation of patient for surgery was less than 12 hours in 83.4% patients. Most
common symptom with which patient presented was abdominal pain (99%) followed
by nausea and vomiting (85%), abdominal distension(71%) and altered bowel
habit(62%). 86% cases had colorectal perforation followed by gastric (11.5%)
and small intestinal (2.5%) perforations. 82.3% had advanced tumour stage. Majority
of colorectal perforation patients underwent Hartmann’s procedure(88.1%). 55.5%
of gastric perforations underwent gastrectomy. Intestinal perforation cases
underwent resection and anastomosis. 52.5% patients received chemotherapy.
Complications included wound infection(31%), electrolyte imbalance(19.5%),
pneumonia(23%), septicaemia(9%), renal failure(8%), intraabdominal abscess(6%).
Mortality rate within one month was 30.7%.

Conclusions:In
developing countries with limited resources, ignorance, financial constraints
and lack of specialist medical knowledge, perforations associated with malignancies
are quite common and lead to increased morbidity and mortality.